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What to Do When Your Workers’ Comp Treatment Claim Is Denied

There are many reasons why a claim for injury compensation might be denied. Workers’ compensation laws that apply to San Jose, CA employees allow an injury claim to be denied. This problem can be avoided by hiring a lawyer to prepare the claim. Other possible reasons for denial can include the lack of witnesses to the injury, lack of supporting medical documentation, and suspicion of pre-existing injury. Even if your claim has been denied, you do have options available to you. It’s best to contact a workers’ compensation attorney to handle your case from this point forward.

Filing an Application for Adjudication of Claim

Your workers’ compensation attorney can file an appeal. In California, this is known as an Application for Adjudication of Claim. To prepare this application, your attorney will need basic information about your injury, such as which body parts were injured, how the injury occurred, when you last worked, and what your earnings were at that time. Your lawyer will file this application in your county office of the Division of Workers’ Compensation (DWC). It must also be served on other parties such as the claims administrator.

Requesting a Hearing

You will receive a notice confirming the filing of your application. You’ll also receive an assigned case number. This case number must be used on all subsequent documents and correspondence. At this point, your lawyer can file a Declaration of Readiness to Proceed, which is a request for a hearing known as a mandatory settlement conference. Hearings can be requested if there is a dispute on issues which can be decided by a judge.

Appearing Before a Judge

You, your attorney, and the counsel for the claims administrator will appear before the judge at the hearing. The judge will encourage the parties to try to reach an agreement. If this is not possible, then your case will go to trial, which is overseen and decided by another judge. After the trial, you’ll receive a written notice of the judge’s decision, usually within 30 to 90 days.

workers compensation claim form

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